By Valerie M. Harvey, MD, MPH
While skin cancers (basal cell carcinoma, squamous cell carcinoma, and melanoma) are less common in minority individuals, outcomes for those patients who do have skin cancer, melanoma in particular, show an area for concern. While general incidence rates for skin cancers in minorities remain lower than that of white patients, we do see a higher degree of late-stage presentation of melanoma among Black, Hispanic, and Asian individuals. Closing this gap in health care requires a three-fold approach: more comprehensive research regarding skin cancer and people of color, increased public education about the risk of skin cancer for individuals of color, and an emphasis on the detection and diagnosis of skin cancers in people of color for clinicians.
While we understand more each day about how skin cancer affects people of color, significant gaps in research remain. For instance, literature on skin cancer and minority populations largely relies on second-hand information from patient charts and skin cancer registries. This information is often devoid of important information regarding ethnicity and race. Moving forward, more critical data-collecting methods will help close these gaps.
In addition to better research, the public needs more information regarding the risk of skin cancer, especially in minority populations. One study examining the perceived risk of skin cancer in minority groups found that 65% of participants viewed themselves as having no risk.1 Increasing public awareness will promote primary preventative behaviors, including the use of sunscreen with SPF 30 or greater, wearing protective clothing and wide-brimmed hats, and scheduling annual skin checkups.
Lastly, as clinicians, we need to emphasize the early detection of skin cancers for minority patients. This involves appropriately educating all patients about skin cancer regardless of race and ethnicity and having a heightened index of suspicion for all patients who present with a questionable skin growth. Research shows that physicians are nine times more likely to recommend sunscreen to their white patients compared to their Black patients.2 Rather than relying on patient inquiry, clinicians can universally advise their patients on the importance of skin self-examination and seeking prompt care for new or changing lesions.
We know that a late-stage skin cancer diagnosis often leads to a poor prognosis. One study found that African American and Asian individuals were more likely to have stage IV melanoma by the time of presentation. Delayed diagnosis is a primary factor contributing to the CDC’s 66.2 percent 5-year melanoma survival rate for non-Hispanic Black Americans in contrast to the 90.1 percent 5-year melanoma survival rate for non-Hispanic white Americans. While there’s a lot of work to do before we see a reduction in this health disparity, interest in closing these gaps in care is increasing. Together, we can create meaningful change for many Americans with skin cancer.
References:
1. Kim M, Boone SL, West DP, et al. Perception of skin cancer risk by those with ethnic skin. Arch Dermatol 2009;145(2):207–8.
2. Cestari T, Buster K. Photoprotection in specific populations: children and people of color. J Am Acad Dermatol 2017;76(3S1):S110–21.
Valerie M. Harvey, MD, MPH, is a Board certified dermatologist with TPMG. She has over a decade of experience specializing in treating common and uncommon skin conditions. She is an active leader in the dermatologic community and serves on numerous boards for the American Academy of Dermatology and Skin of Color Society. mytpmg.com
